Patient Survey Results After use of Integrated EHR ......• Summary results copy-paste into patient...
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Patient Survey Results After use of Integrated EHR Decision Tool Jon Keevil 1 , MD; Amy Zelenski 1 , PhD; Margaret Leaf 2 MS University of Wisconsin (1)School of Medicine and Public Health, Dept of Medicine; (2)Hospital and Clinics HealthDecision has built 3 additional tools: • Anticoagulation for Atrial Fibrillation • Mammography Risk Benefit • Lung Cancer Screening CT Risk Benefit The platform is built for SDM tool collaboration HD is scheduled to install into 2 more EHRs Discussion Purpose: We investigated associations between clinical use of HealthDecision, a shared decision-making (SDM) tool embedded in the medical record of an academic medical institution, with results of patient satisfaction surveys. Method: We identified patient surveys returned for visits during which HealthDecision was used and compared results with surveys from similar patients seeing the same providers during visits not using HealthDecision. Using logistic regression, we compared survey results between groups, controlling for level of provider experience with the tool. We also compared the proportion of “strongly agree” responses for the two groups using z-tests. We evaluated survey questions related to the goals of shared decision making, as well as questions that appear unrelated. Result: Between 2010 and 2015, 1305 different providers opened HealthDecision within charts of over 28,000 patients. Of these, 982 patients seen by 184 providers completed 1,014 surveys. By comparison, 22,681 patients seeing the same 184 providers completed an additional 30,617 surveys for visits not using HealthDecision. Patients whose visit included HealthDecision were significantly more likely to “strongly agree” with survey items related to shared-decision making, including: “I was given the chance by my provider to provide input to decisions about my healthcare,” (OR=1.26 p=.048) “My provider answered my questions about my health,” (OR=1.29 p=.045) and “My provider showed concern and sensitivity to my needs” (OR=1.30 p=.0439). These effects remained significant when controlling for provider’s experience with the tool. By comparison, responses to questions unrelated to the visit (e.g.“My needs were handled promptly and efficiently by the office staff.”) did not significantly vary based on use of HealthDecision. The z-test produced similar results: The proportion of “strongly agree” responses was significantly higher (p<.05) for 3 provider communication questions when HealthDecision was used, compared to visits when it was not used. Conclusion: Over 5 years at an academic medical center, use of an embedded decision tool was associated with significantly higher patient survey ratings, particularly for questions related to provider-patient communication. While not proof of causality, the association suggests that use of HealthDecision within the clinic visit may improve the patient’s experience. Future research should focus on how providers are using the tool before, during, and after clinic visits and investigate the reasons for the improved responses. Tool Background HealthDecision (HD) is a SDM tool to guide statin use, triggered by provider: • Patient’s data imports to HD’s separate servers • Interactive results display within chart to support discussion • Summary results copy-paste into patient instructions 2010 – 2015: 1305 providers used the tool for 28,000 patients This usage data was returned to UW Health, decrypted, filtered and combined with associated patient satisfaction surveys. The study met IRB standards for a quality evaluation. Near Future Abstract Study Group: • 982 patients completed 1,014 surveys for visits with • 184 providers who had opened HD the same day Comparison group • 22,681 patients completed 30,600 surveys for • same 184 providers who did NOT open HD Chart shows 13 of 43 items • compared with two-tailed z-test for 2 proportions • 5 Items meet significance (p < .05) • Yellow = Below UW Health Target • Green = Meets UW Health Target Evaluation #1: Surveys with & without HealthDecision tool use All 240 primary care physicians and APPs • Grouped by # of patients with HD used • Filtered out HD sessions without cardiac risk score • FY15 survey items evaluated across groups 3 usage groups compared to zero use group • Two-tailed z-test for two proportions • Point marker identify significant change from zero use Figure shows • 7 items with increased scores for users vs non-users • 1 item without significant change (“seen on time”) Evaluation #2: Surveys grouped by provider’s experience with HealthDecision These data show a positive association between use of the HD SDM tool and increased patient satisfaction. Evaluation #1 demonstrates improved scores between tool-use and non-tool-use patients of the same providers. This suggests influence of tool use per provider. Evaluation #2 shows higher scores for providers with greater experience with the tools. This suggests a graded impact of tool use on providers that may accumulate over time. Use of the HealthDecision tool was associated with higher patient satisfaction in communication domains; and this impact was greater for the physicians with more experience using the tool. Most domains not showing improvement were associated with logistics of clinic flow. This suggests that the improved experience for the patient is focused on areas of the provider interaction.
Transcript of Patient Survey Results After use of Integrated EHR ......• Summary results copy-paste into patient...
Patient Survey Results After use of Integrated EHR Decision ToolJon Keevil1, MD; Amy Zelenski1, PhD; Margaret Leaf2 MS
University of Wisconsin (1)School of Medicine and Public Health, Dept of Medicine; (2)Hospital and Clinics
HealthDecision has built 3 additional tools:• Anticoagulation for Atrial Fibrillation• Mammography Risk Benefit• Lung Cancer Screening CT Risk Benefit
The platform is built for SDM tool collaborationHD is scheduled to install into 2 more EHRs
DiscussionPurpose: We investigated associations between clinical use of HealthDecision, a shared decision-making (SDM) tool embedded in the medical record of an academic medical institution, with results of patient satisfaction surveys.
Method: We identified patient surveys returned for visits during which HealthDecision was used and compared results with surveys from similar patients seeing the same providers during visits not using HealthDecision. Using logistic regression, we compared survey results between groups, controlling for level of provider experience with the tool. We also compared the proportion of “strongly agree” responses for the two groups using z-tests. We evaluated survey questions related to the goals of shared decision making, as well as questions that appear unrelated.
Result: Between 2010 and 2015, 1305 different providers opened HealthDecision within charts of over 28,000 patients. Of these, 982 patients seen by 184 providers completed 1,014 surveys. By comparison, 22,681 patients seeing the same 184 providers completed an additional 30,617 surveys for visits not using HealthDecision. Patients whose visit included HealthDecision were significantly more likely to “strongly agree” with survey items related to shared-decision making, including: “I was given the chance by my provider to provide input to decisions about my healthcare,” (OR=1.26 p=.048) “My provider answered my questions about my health,” (OR=1.29 p=.045) and “My provider showed concern and sensitivity to my needs” (OR=1.30 p=.0439). These effects remained significant when controlling for provider’s experience with the tool. By comparison, responses to questions unrelated to the visit (e.g.“My needs were handled promptly and efficiently by the office staff.”) did not significantly vary based on use of HealthDecision. The z-test produced similar results: The proportion of “strongly agree” responses was significantly higher (p<.05) for 3 provider communication questions when HealthDecision was used, compared to visits when it was not used.
Conclusion: Over 5 years at an academic medical center, use of an embedded decision tool was associated with significantly higher patient survey ratings, particularly for questions related to provider-patient communication.While not proof of causality, the association suggests that use of HealthDecision within the clinic visit may improve the patient’s experience. Future research should focus on how providers are using the tool before, during, and after clinic visits and investigate the reasons for the improved responses.
Tool BackgroundHealthDecision (HD) is a SDM tool to guide statin use, triggered by provider:
• Patient’s data imports to HD’s separate servers• Interactive results display within chart to support discussion• Summary results copy-paste into patient instructions
2010 – 2015: 1305 providers used the tool for 28,000 patientsThis usage data was returned to UW Health, decrypted, filtered and
combined with associated patient satisfaction surveys.The study met IRB standards for a quality evaluation.
Near Future
Abstract
Study Group:• 982 patients completed 1,014 surveys for visits with• 184 providers who had opened HD the same day
Comparison group• 22,681 patients completed 30,600 surveys for• same 184 providers who did NOT open HD
Chart shows 13 of 43 items• compared with two-tailed z-test for 2 proportions• 5 Items meet significance (p < .05)• Yellow = Below UW Health Target• Green = Meets UW Health Target
Evaluation #1: Surveys with & without HealthDecision tool use
All 240 primary care physicians and APPs• Grouped by # of patients with HD used• Filtered out HD sessions without cardiac risk score• FY15 survey items evaluated across groups
3 usage groups compared to zero use group• Two-tailed z-test for two proportions• Point marker identify significant change from zero use
Figure shows• 7 items with increased scores for users vs non-users• 1 item without significant change (“seen on time”)
Evaluation #2: Surveys grouped by provider’s experience with HealthDecision
These data show a positive association between use of the HD SDM tool and increased patient satisfaction.
Evaluation #1 demonstrates improved scores between tool-use and non-tool-use patients of the same providers. This suggests influence of tool use per provider.
Evaluation #2 shows higher scores for providers with greater experience with the tools. This suggests a graded impact of tool use on providers that may accumulate over time.
Use of the HealthDecision tool was associated with higher patient satisfaction in communication domains; and this impact was greater for the physicians with more experience using the tool. Most domains not showing improvement were associated with logistics of clinic flow. This suggests that the improved experience for the patient is focused on areas of the provider interaction.
